Provider Demographics
NPI:1558031724
Name:TRAHAN, KIM (MS, RDN)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:TRAHAN
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2826
Mailing Address - Country:US
Mailing Address - Phone:410-627-0345
Mailing Address - Fax:
Practice Address - Street 1:440 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-2826
Practice Address - Country:US
Practice Address - Phone:410-627-0345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDB00231133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered